MedicaidAdministrativeMedium impact
[Ohio] Medicaid 2027 work requirements: What care providers need to know
Anthem BCBS·OH·Government Programs
Effective date
Jan 1, 2027
We identified it
Aug 3, 2026
Summary
Effective January 1, 2027, Ohio Anthem Medicaid will enforce new federal work requirements for certain non-disabled adults ages 19-64 in the Medicaid expansion population. Members must report 80 hours per month of work, school attendance, community service, or combination activities to maintain eligibility. Anthem will verify eligibility through data sources when possible, but some members will need to complete manual verification processes. Care providers should remind patients to keep contact information current to receive notices.
Action Required
By November 1, 2026: Front desk and patient service staff should begin reminding all Anthem Medicaid patients in Ohio to verify and update their contact information (phone, email, mailing address) in the billing system. This ensures patients receive eligibility determination notices from Anthem. By December 15, 2026: Billing team should review patient rosters for Anthem Medicaid members ages 19-64 without documented disabilities or qualifying conditions and flag accounts for potential eligibility changes. Beginning January 1, 2027: Billing team must verify Medicaid eligibility for all Anthem Ohio patients at each visit, as coverage may be lost if work requirements are not met. Implement procedures to check eligibility status before processing claims. If a claim is denied due to work requirement non-compliance, contact the patient to inform them of the requirement and direct them to contact Anthem or refer to the Medicaid Work Requirements FAQ. Do NOT bill patients for services rendered under the assumption of Medicaid coverage if eligibility has lapsed due to unmet work requirements without first clarifying member responsibility.